P. J. Parikh1, B. Guthrie1, T. Erskine2, M. McCarthy1, P. P. Parikh1 1Wright State University,Dayton, OH, USA 2Ohio Department Of Public Safety,Emergency Medical Services,Columbus, OH, USA
Introduction:
Previous studies suggest that geographic distribution of trauma centers correlates with injury-related mortality. However, the impact of distribution of trauma centers on system performance in the state, including statewide resource utilization and patient care is unclear.
Methods:
All trauma and emergency medical services (EMS) data for 2008-2012 were obtained from the Ohio Department of Public Safety (ODPS), which included 34,494 unique patient records. Overtriage (OT) error was defined as the proportion of patients with ISS≤15 transported to a Level 1/2 trauma center; undertriage (UT) error referred to patients ISS>15 transported to a Level 3 or non-trauma center, where OT indicates resource utilization, and UT and mortality directly impact patient care. Proportions of patients experiencing OT and UT errors, and subsequent mortality across all the homeland security regions of Ohio were compared.
Results:
Over- and under-triage errors showed specific patterns by region (Table 1). For instance, Regions 7 and 8 had the highest UT (4.6% and 12.9%, respectively) and lowest OT (24.4% and 3.2%, respectively) errors. Because there are no L1/L2 trauma centers in these regions, triage patients are likely to be transferred from the scene to the nearest L3 or non-trauma facilities. Similarly, Regions 2 and 5 have the least UT errors (1.8% and 1.5%, respectively) and the highest OT errors (49.4% and 61.5%, respectively), probably because of the ease of accessible L1/L2 centers prompting even less severely-injured patients to be transferred there. Although mortality did not vary substantially between the regions, it was the highest in Region 8 (6.2%).
Conclusion:
The location of trauma centers in the region can directly affect quality care access and resource utilization in any trauma system. A model or tool that could help the state identify the optimal distribution of trauma centers could improve equity of care among these regions while optimizing trauma resources.
